Baseline Features and Reasons for Nonparticipation in the Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) Study, a Colorectal Cancer Screening Trial
Authors: Douglas J. Robertson, Jason A. Dominitz, Alexander Beed, Kathy D. Boardman, Barbara J. Del Curto, Peter D. Guarino, Thomas F. Imperiale, Andrew LaCasse, Meaghan F. Larson, Samir Gupta, David Lieberman, Beata Planeta, Aasma Shaukat, Shanaz Sultan, Stacy B. Menees, Sameer D. Saini, Philip Schoenfeld, Stephan Goebel, Erik C. von Rosenvinge, Gyorgy Baffy, Ildiko Halasz, Marcos C. Pedrosa, Lyn Sue Kahng, Riaz Cassim, Katarina B. Greer, Margaret F. Kinnard, Divya B. Bhatt, Kerry B. Dunbar, William V. Harford, John A. Mengshol, Jed E. Olson, Swati G. Patel, Fadi Antaki, Deborah A. Fisher, Brian A. Sullivan, Christopher Lenza, Devang N. Prajapati, Helen Wong, Rebecca Beyth, John G. Lieb, Joseph Manlolo, Fernando V. Ona, Rhonda A. Cole, Natalia Khalaf, Charles J. Kahi, Divyanshoo Rai Kohli, Tarun Rai, Prateek Sharma, Jiannis Anastasiou, Curt Hagedorn, Ronald S. Fernando, Christian S. Jackson, M. Mazen Jamal, Robert H. Lee, Farrukh Merchant, Folasade P. May, Joseph R. Pisegna, Endashaw Omer, Dipendra Parajuli, Adnan Said, Toan D. Nguyen, Claudio Ruben Tombazzi, Paul A. Feldman, Leslie Jacob, Rachel N. Koppelman, Kyle P. Lehenbauer, Deepak S. Desai, Mohammad F. Madhoun, William M. Tierney, Minh Q. Ho, Heather J. Hockman, Christopher Lopez, Emily Carter Paulson, Martin Tobi, Hugo L. Pinillos, Michele Young, Nancy C. Ho, Ranjan Mascarenhas, Kirrichai Promrat, Pritesh R. Mutha, William M. Pandak, Tilak Shah, Mitchell Schubert, Frank S. Pancotto, Andrew J. Gawron, Amelia E. Underwood, Samuel B. Ho, Priscilla Magno-Pagatzaurtundua, Doris H. Toro, Charles H. Beymer, Andrew M. Kaz, Jill Elwing, Jeffrey A. Gill, Susan F. Goldsmith, Michael D. Yao, Petr Protiva, Heiko Pohl, Tassos Kyriakides, Elaine Kleiner, Kathy Sullivan, John O'Leary, Wai (Susannah) Chiu, Hairong Huang, John Russo, Gary Johnson, Peg Antonelli, Amy Burns, Peter Peduzzi, Maria Ciarleglio, Theresa O'Connor, Robert Wallace, Alicia Williams, Lynn Tommessilli, Sakasha Taylor, Sarah Pitts, Lesley W. Mancini, Peggy O'Brien, Susan O'Neil, Mavis Perry, Vanessa McBride, Wanda Carr, Carmelene Joncas, Elizabeth O'Donnell, Mike Sather, Stuart Warren, Todd Conner, Ernestine Honstein, Theresa Sutton, Tracey Putnam, Kevin Branham, Dean Argyres, Dianne Peterson, April Kennedy, Toni Carrick, Carlos Apodaca, Gary Eden, Talaya Martinez, Cindy Tripp, Michelle Nicholson, Amy Schwartz, Monique Felix, Angela Ward, Leanne Marquez, Karsondra Lovato, Neil Cochran, Steve Tapia, Melissa VanRaden, Carol Badgett, Zach Taylor, Jimmy Pontzer, Bert Dorman, Michael Chavez, Sharon Georg, Terri Templton, Lawrence Calais, Claire Haakensen, Barbara Curtis, Michelle Prehoda, Cindy Colling, Dave Older, Gloria Apodaca, Julia Sova, Magnolia C. Klee, Antigone Wolfram-Aduan, Michael J. Ulatowski, Brittney L. Hamilton, Kayla M. Bopp
(Formerly England), Gashia M. Ford, Ngaio E. Lace, William A. McDonnell, Gina C. Piehl, Nazleen Patel-Ejarque, Maegan Berry, Eric A. Strubeck, Leigh Chesnut, Laurie J. Burridge, Jennifer R. Bean, Lynda M. Kowal, Amy V. Voorhees
(Formerly Rose), Amy Ridley, Heike B. Croteau, Kate A. Bessett, Carol Fletcher, Michelle Barbaresso, Alysia Drummond, Karen Belanger, Erin McRobert, Aimee Myers, Erika Trumble, Patricia Rose, Anita Biswas, Eric Enache, Matthew Shankin, Danielle Strunk, Andrew Simpson, Melanie Harrison, Meena Prasad, Pauline Robinson, Alegandro Flores, Sara Jananeh, Sridhar Tanukonda, Ghazal Ahmadi-Izadi, Shahrzad Madihi, Jean-Pierre Raufman, Deborah Grady, Angela Britton, Carly Goldstein, Michelle Thomas, Veronica Lee, Myrdell Belizaire, Caroline Costa, Samuel Davis, Makaila Decker, Ashley Marrama, Dorothy Gilroy-Fanaras, Jesse Gass, Scott Reece, Desiree Tobin, Robert Carroll, Maria Ferreira, Dawn Irvin, Victoria Morken, Michael Covelli, Teodoro Medina, Frank Schiebel, Anna Shreves, Donald Shriver, Yvonne Frederick, Candice Postle (formerly Matheny), Jessica Shaw, Dorothy Pastor, Anna Armstrong, Vinay Kumaran, April Jessica Pinto, Vanessa Marshall, Stacye McLarty, James Carlton, Kenneth Murphy, Kourtney McLemore, Eric Mortensen, James LePage, Cyenthia Willis, Kenneth Berman, Theresa Dunn, Jeannine Espinoza, Eugenia (Jean) Schleski, Stephanie Shrader, Kevin Gropp, Ziad Kanaan, Lawrence Miller, Mohammad Anees, Stephanie Judd, Vicki Berchou, Deann Balogh, Elizabeth Jones, Kathleen 'Kelly' Covert, Yolanda Davis, Cynthia Marbury, MaryAnn Rambus, Erin Olgren, Ziad Gellad, Brian Sullivan, Teresa Day, Sima Teehan, Laura Peters, Raquel Hernandez-Chavez, Eva Murphy, Judy (Christine) Cherry, Edwin Graham, Judith Johnson, William Wooten, Jesus Trujillo, Maurice Harris, Mary Alizadeh, Margaret Lo, Shannaz Sultan, Leslie Brown, Lauren Koster, Jennifer LeLaurin, Anne Irwin, Nicole Kay, Sean Mckillip, Mark Lowe, Seyhun Yeralan, David Leehey, Conor McBurney, Amod Jain, Thomas Park, Latonia Broadwater, Hashem El-Serag, Yassir Shaib, Eric Taylor, Paayal Nair, Emily Broussard, Erica Gibson, Rollin Hawkins, Tammy Natividad, Daisy Courtade, Mayuri (Ezzie) Palmer, Stephanie Martinez, Kougias Panagiotis, Curlie Morrow, Carrie Ballard, Barry Barker, Mikayla Garner, Stephanie McCalley, Ashley Schwartzkopf, Anita Wright, Mohammad Titi, April Higbee, Singh Pratiksha, April Jones, Tracey Shipe, Jason McKee, Raghuram Vennalaganti, Kira Terrey, Lubna Maruf, Daniel Brown, Elaine Crouse, Kathy Marchant-Miros, Betty Ussery, Loretta Ducker, Jennifer Estell, Sylvia Porchia, Mi Ye Kim, Christina Kim, Bobby Chan, Amy Hayton, Harini Christiansen, Myra Peterson, Guizhi (Grace) Ding, Vicki Simpson, Sonia Read, Gabriela Mamani, Jordan Salazar, Joann Kato, Michael Bowie, Ryan Carnevale, Mark Halim, Anita Sahagian, Allison Ibarra, Zachary Travis, Julia Garcia, Abneet Gill, John Starzyk, Samantha Sumarli, Valanteena Johnson, Simbiso Peresuh, Traci Quimby, Rick Cordova, Lauren Herold, Angela Hawley, Tyralee Goo, Jayashri Kidao, Robert Lee, Collin Freidel, Evelyn Gutierrez, Negar Noorisharghi, Gabrielle Evanne-Mignon Ivie, Tamara Jawish, Steven Partin, Grace Yoo, Charina Fabilane, Nikoo Noori, Elizabeth Lang, Shazie Senen, Stephen Partin, Moe Fathi, Rachel Chauvin, Jeremy Feiger, Marielle Reataza, Timothy Morgan, Aliya Asghar, Jonathan Jacobs, Mehran Kashefi, Folasade May, Gordon Ohning, David Padua, Victoria Smutko, David Oh, Hovsep Kosoyan, Benjamin Dreskin, Kayti Luu, Alexander Alas, Purnima Bharath, Vivek Dixit, Daniel Sanford**, John Vu, Samar Kadi, Tracy Nwajuaku, June Smith, Jenevieve Kincaid, Mohammed Mir, Joel Lanceta, John Rice, Parul Agarwal, Alexia Augustine, Helene Prickel, Jenny Vue, Kevin Guerrero, Stewart Levenson, Andres Aguilera-Fish, Leigh Chestnut, Bruce Jobse, Cathy Lombardo, Trudi Silver, Nazneen Ahmed, Kathleen Bockhold, Rachel Koppelman, Flavia Rosa Carneiro, Rolando Garcia-Morales, Daniel Spector, Jose Gomez, Kyle Lehenbauer, Andrew Reinink, Ruth Anway, Mary Evans-Lindquist, Thomasine Eggers, Michele Green, Alex Pretti, Tacy Meyeraan, Debra Condon, Mary Cavanagh, Colleen M. DeFalco, Jacqueline Cutting, Kurt Joseph, Stephanie Dean, Stephanie Mitchell, Vickie Phillips, Chelsey Krueger, Donna Zink, Kenneth Goldberg, Nitin Patel, Maria Martinez Gonzalez, Heather Davis-Underwood, Andrea O'Sullivan, Trisha Suppes, Karen Bratcher, David Stern, Richard Wu, Jibreel Damisa, Rahma Warsi, Tam Nguyen, Hugo Pinillos, Erin Flowers, Angela Kuramoto, Charles Thurmond, Lisa Orozco, Gail Farrell, Rodney Jaynes, Perfecto Saenz, Cassandra Perez, Judith Collins, Emery Lin, Laura Onstad, Alexandra Pitts, Kevin Osborn, Tawni Kenworthy-Heinige, Andrew Casey, Deanna Gold, Cosette Olivo, Sandra Joos, Sandhya Subramanian, Vanessa Forro, Allina Cannady, Joy Usih, Merritt Raitt, Maura Flynn, Yetunde Shittu, Muhammad Jawaid, Rebecca Anderson, Deanna Poole, Celia Butler, Leanne Snead, Hayden Christine, Gina Swanson, Douglas Heumann, William Pandak, Joseph Spataro, Jasmohan Bajaj, Cynthia Solomon, HoChong Smith Gilles, Alvin Zafass, Shan Tilak, Michael Fuchs, Margaret Davis, Lou Blackman, Jennifer Lemler, Rachel Munsey, Jeanette Deebo, Jane McCarthy, Megan Noel, Robin Hurley, Wayner Zurowski, Angela Sharpe, Krystina Wilson, Risa Peets, Benjamin Lorenso, Stephanie Burrison, Dorothea Johnson, Aaron Angelovic, Nathan Erickson, Heather Hanson, Travis Bailey, Kim Genung, Heather Dulin, Renee Neuharth, Daniel Clegg, Kandi Velarde, John Dever, Mary Murphy, Danielle Beck, Michelene Wasil, Jason Vazquez, Ellen O'Neil, Gelareh Ganji, Julie Ducom, Maria Lee, Rita Hovespians, Jessie Margolis, Brittni Simmons, Jennifer Sweeney (formerly St. Martin), Robert Henry, Jose Martin-Ortiz, Loscar Santiago-Rivera, Gladys Gonzalez - Aviles, Carmen Pedrosa, Juan Bird-Caceres, Brunilda Padilla, Fernando Baez-Corujo, Yaiza Martinez- Ortiz, Ekie Vazquez, Nicole Grigg-Gutierrez, Carlos Laboy-Olivieri, Rafael Urbina-Velez, Sarah Andrews, Sheryl Rosa-Cruz, Rafael Tirado-Montijo, Kayssa Otero-Aponte, Michelle Martinez-Martino, Arnaldo Freire, Antonio Soto-Ramos, Margarita Santana-Perez, James Araujo, Christopher Vanderwarker, Jeremiah Alexander, Elaine Nevins, Julie LaGuire, Linda Guerrero, Gina Piehl, Meredith Jenkins, Teresa Chen, Jessica Jang, Adrienne Tanus, Patricia McKelvy, Gregory Sayuk, Pooja Chandiramani, Lindsey Vargo
(Formerly Shoults), Kristin Vargo, Sara Lawrence, Kelly Blythe, Susan Goldsmith, Robert Campbell, Mary Agnes Craddock, Donald Amodeo, Rebecca Reinhard, Brittany Durant, Breanna Wells, Adam Zoble, Marianna Papademetriou, Nada Roche, Priscilla Adler, Asha Krishna, Delmonica Glaze, Dinuka Wijegunawardana, Samuel Yeroushalmi, Loren Laine, Raeleen Mautner, Julie Bugaj, Joseph Anderson, Heike Croteau, Linda Kingman, Laurie Burridge
Journal: JAMA Network Open (2023)

Importance The Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) randomized clinical trial sought to recruit 50 000 adults into a study comparing colorectal cancer (CRC) mortality outcomes after randomization to either an annual fecal immunochemical test (FIT) or colonoscopy. Objective To (1) describe study participant characteristics and (2) examine who declined participation because of a preference for colonoscopy or stool testing (ie, fecal occult blood test [FOBT]/FIT) and assess that preference’s association with geographic and temporal factors. Design, Setting, and Participants This cross-sectional study within CONFIRM, which completed enrollment through 46 Department of Veterans Affairs medical centers between May 22, 2012, and December 1, 2017, with follow-up planned through 2028, comprised veterans aged 50 to 75 years with an average CRC risk and due for screening. Data were analyzed between March 7 and December 5, 2022. Exposure Case report forms were used to capture enrolled participant data and reasons for declining participation among otherwise eligible individuals. Main Outcomes and Measures Descriptive statistics were used to characterize the cohort overall and by intervention. Among individuals declining participation, logistic regression was used to compare preference for FOBT/FIT or colonoscopy by recruitment region and year. Results A total of 50 126 participants were recruited (mean [SD] age, 59.1 [6.9] years; 46 618 [93.0%] male and 3508 [7.0%] female). The cohort was racially and ethnically diverse, with 748 (1.5%) identifying as Asian, 12 021 (24.0%) as Black, 415 (0.8%) as Native American or Alaska Native, 34 629 (69.1%) as White, and 1877 (3.7%) as other race, including multiracial; and 5734 (11.4%) as having Hispanic ethnicity. Of the 11 109 eligible individuals who declined participation (18.0%), 4824 (43.4%) declined due to a stated preference for a specific screening test, with FOBT/FIT being the most preferred method (2820 [58.5%]) vs colonoscopy (1958 [40.6%]; P &amp;amp;lt; .001) or other screening tests (46 [1.0%] P &amp;amp;lt; .001). Preference for FOBT/FIT was strongest in the West (963 of 1472 [65.4%]) and modest elsewhere, ranging from 199 of 371 (53.6%) in the Northeast to 884 of 1543 (57.3%) in the Midwest ( P = .001). Adjusting for region, the preference for FOBT/FIT increased by 19% per recruitment year (odds ratio, 1.19; 95% CI, 1.14-1.25). Conclusions and Relevance In this cross-sectional analysis of veterans choosing nonenrollment in the CONFIRM study, those who declined participation more often preferred FOBT or FIT over colonoscopy. This preference increased over time and was strongest in the western US and may provide insight into trends in CRC screening preferences.